Provider Demographics
NPI:1386261386
Name:PUMA, LILLIAN DOLORES (DO)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:DOLORES
Last Name:PUMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6349 E JOAN DE ARC AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3834
Mailing Address - Country:US
Mailing Address - Phone:602-657-6759
Mailing Address - Fax:480-998-7706
Practice Address - Street 1:6349 E JOAN DE ARC AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3834
Practice Address - Country:US
Practice Address - Phone:602-657-6759
Practice Address - Fax:480-998-7706
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine